Dual Stimulation for Spinal Cord Injury

Device feasibility will be evaluated by device operability throughout the intervention period, these measurements will include; skin bioimpedance (Ohms), ramping up and down of electrical current in mA, and voltage stability during the stimulation (mA) period.

Skin bioimpedance, ramping, and voltage stability will be combined to report device functionality represented as optimal stimulation or non-optimal.

Number of Participants presenting Treatment-Related Adverse Events as Assessed by Common Terminology Criteria for Adverse Events (CTCAE)

It's a universal classification tool for spinal cord injuries based on a standardized sensory and motor assessment. It involves a Motor and Sensory examination to determine the Sensory Level and Motor Level for each side of the body (Right and Left), the single Neurological Level of Injury (NLI), and whether the injury is Complete or Incomplete. ASIA is a standardized examination consisting of a myotonic-based motor examination, a dermatomal-based sensory examination, and an anorectal examination. Based on the findings of these examinations, injury severity or grade and level are assigned.

Visual Analogue Scale (VAS) is a measurement instrument that tries to measure a characteristic or attitude that is believed to range across a continuum of values and cannot easily be directly measured. They are generally completed by patients but are sometimes used to elicit opinions from health professionals.

Reflexes assessed by the treating physician during physical examination by exploring the extremities affected by the site of injury.

SCI-FI is a system of patient-reported outcome measures of functional activities developed specifically with and for individuals with spinal cord injury (SCI). It consists of 9-item response theory-calibrated item banks that represent relevant and meaningful item content for individuals with SCI, span a wide range of functional abilities, and subdivide physical functioning into important subdomains, including essential mobility, self-care, and fine motor function. The SCI-FI measures five subdomains; the investigators will include three subdomains of physical function: virtual mobility, self-care, and ambulation in a conceptual structure unique to individuals with SCI.

MAS is a six-category ordinal scale used to assess the resistance encountered during passive muscle stretching that does not require instrumentation and is quick to perform. The MAS is the current standard for clinical assessment of lower extremity spasticity and the most commonly used tool to evaluate the efficacy of pharmacologic and rehabilitation interventions for treating spasticity among patients with SCI. The MAS is the gold standard against which new assessment tools are evaluated.

SCI-QOL is a measurement system that was developed to address the shortage of relevant and psychometrically sound patient-reported outcome (PRO) measures available for clinical care and research in (SCI) rehabilitation. It consists of 19 item banks, including the SCI-Functional Index banks, and three fixed-length scales measuring physical, emotional, and social aspects of health-related QOL (HRQOL)

The FACIT Fatigue Scale is a short, 13-item, easy to administer tool that measures an individual's level of fatigue during their usual daily activities over the past week. The level of fatigue is measured on a four-point Likert scale (4 = not at all fatigued to 0 = very much fatigued)

The Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) is a brief, portable and easy-to-administer cognitive screening instrument developed at the Neuropsychiatry Unit of the Royal Melbourne Hospital, Australia, for use in psychiatric and neurologic patient populations, with an emphasis on balancing breadth and brevity, while ensuring sensitivity to the subtle changes seen across a range of disorders. It consists of 21 items that assess cognitive function across five cognitive functional domains: attention, memory, executive, visuo-constructional, and language, and is based on established cognitive tests, with items similar to those found in other cognitive screening tools. It has been designed to be administered in approximately 20 to 30 minutes. The NUCOG provides a total score of 100, with each of the five domains having a total score of 20.

High-density surface electromyography (HD-sEMG): is a non-invasive technique to measure electrical muscle activity with multiple (more than two) closely spaced electrodes overlying a restricted skin area. It is a method for recording Motor Unit Action Potentials (MUAP) over a muscle, using 2D arrays of closely spaced electrodes. Unlike traditional surface electromyography (sEMG), it accounts for both the signal's spatial and temporal characteristics, allowing a broader assessment of muscle electrophysiological activity.

SSR is a convenient, non-invasive measure of autonomic function in various conditions, including SCI. It represents one of many techniques available to directly or indirectly measure sympathetic outflow to the skin. A measure of sympathetic cholinergic sudomotor function has been used to assess autonomic dysfunction in patients with spinal cord injury (SCI). It can be a useful surrogate measure of global autonomic function in research and as a diagnostic tool.

The investigators will record skin pictures before and after each intervention to document safety, the investigators will only include the site where the electrodes are placed (wrist, neck, and abdomen), and the investigators won't have any identifiable features of the subject, like face, birthmarks, or tattoos. The investigators will get consent to perform this and provide a written agreement document to sign at the beginning of the study.